Comparing visual estimation and hematocrit change in the assessment of blood loss among women undergoing cesarean delivery in a tertiary facility in northern Uganda

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dc.contributor.authorRobert Edilu
dc.contributor.authorRitah Nantale
dc.contributor.authorAaron Sanvu
dc.contributor.authorJames Ecuut
dc.contributor.authorAlban Odong
dc.contributor.authorFelix Bongomin
dc.contributor.authorJackline Ayikoru,
dc.contributor.authorBaifa Arwinyo,
dc.contributor.authorSande Ojara
dc.contributor.authorPebalo Francis Pebolo
dc.date.accessioned2025-09-02T10:33:44Z
dc.date.available2025-09-02T10:33:44Z
dc.date.issued2024
dc.descriptionWe acknowledge the support from the PPH committee, Laboratory of Gulu Regional Referral Hospital, and Gulu University Research and Ethics Committee. We acknowledge the contribution of the following people: (1) Mrs. Lamaro Harriet—Gulu Regional Referral Hospital; (2) Mr. Okumu Thomas—Gulu Regional Referral Hospital; (3) Mr. Tito Okello Lutwa—Gulu Regional Referral Hospital; (4) Mrs. Acayo Irene—Gulu Regional Referral Hospital; and (5)Mr. Kiduma Robert—Gulu University
dc.description.abstractBackground: Cesarean section poses a fourfold risk for postpartum hemorrhage (PPH), necessitating accurate blood loss estimation to enable timely interventions. However, the conventional visual estimation method often leads to underestimation, resulting in undiagnosed PPH even in our setting, Uganda. Yet, the quantitative standard techniques remain underutilized. Objective: We compared visual and calculated blood loss among women undergoing cesarean delivery at Gulu Regional Referral Hospital in northern Uganda. Design: We employed a cross-sectional study design. Methods: We enrolled pregnant women scheduled for cesarean section and determined both calculated and visually estimated blood loss. Data analysis involved using Pearson’s moment correlation coefficient to compare the two methods and logistic regression to determine the factors associated with PPH. Results: We included 105 participants, most were primigravida (n = 100, 43%), aged 15–24 years (n = 100, 52%), with term gestation (n = 100, 75%). The mean visual estimated blood loss (vEBL) was 235.3 ± 123.7 ml (interquartile range (IQR) 50–600 ml), while the calculated estimated blood loss (cEBL) was 435.0 ± 1328.2 ml (IQR −11,182.1–2226.7 ml). Visual estimation underestimated blood loss in 90% of cases (n = 100), and 21% (n = 21) had undiagnosed PPH (>1000 ml blood loss). None of the respondents had PPH (>1000 ml blood loss) following vEBL. There was a small positive correlation between both methods (vEBL and cEBL; r = 0.1165; p = 0.2482). Women aged >35 years were 1.60 times more likely to experience PPH than their counterparts aged 25–34 years (adjusted odds ratio (AOR): 1.60; 95% CI: 1.11–2.30, p < 0.011). Chorioamnionitis increased the risk of PPH by 2.2 times (AOR: 2.20; 95% CI: 1.20–4.05, p < 0.012). Conclusion: The visual estimation technique significantly underestimated blood loss in up to 90% of cases, particularly during emergency cesarean sections. Among the 21% of cases diagnosed with PPH based on calculated blood loss, advanced maternal age and chorioamnionitis were notable contributing factors. Routine hemoglobin and hematocrit testing in obstetric care can be effectively utilized to objectively assess blood loss, aiding in the accurate diagnosis and management of PPH. Implementing these measures, even in resourceconstrained settings, can significantly reduce the morbidity and mortality associated with PPH
dc.identifier.otherDOI: 10.1177/ 26334941241289552
dc.identifier.urihttp://hdl.handle.net/20.500.14270/626
dc.language.isoen
dc.publisherTherapeutic advances in reproductive health
dc.subjectGulu
dc.subjecthemoglobin
dc.subjectmaternal mortality
dc.subjectpostpartum hemorrhage
dc.subjectUganda
dc.subjectunderestimation
dc.titleComparing visual estimation and hematocrit change in the assessment of blood loss among women undergoing cesarean delivery in a tertiary facility in northern Uganda
dc.typeArticle

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